Low blood counts 

• Red blood cells (RBC) contain hemoglobin which carries oxygen to all parts of the body.  
• When your hemoglobin count is low, your body tissues do not get enough oxygen to do their jobs properly. This condition is called anemia.  
• If you develop anemia you may feel tired, weak, dizzy or short of breath.  
• You will be given blood transfusions when your hemoglobin count is below 70 or earlier if you have symptoms that are troublesome.  
• Some people get chills, hives or shortness of breath during blood transfusions and need medications to prevent this from happening. Let the team know if you have ever had any of these problems with blood transfusions in the past.  

There are also some things you can do to help yourself feel better:  

• Get plenty of rest to conserve your energy. Have only short periods of activity and follow it by a period of rest.  
• Move slowly to avoid getting dizzy. For example, when you are getting out of bed, don’t get up quickly. Instead, sit on the side of the bed before you stand up. If you still feel dizzy, ask for help.  

Platelets are cells that form clots to stop bleeding. When you do not have enough platelets in your blood, you may bleed or bruise more easily than usual even when an injury is very minor.  

The signs of bleeding from a low platelet count are:  

• Nosebleeds  
• Easy bruising  
• Bleeding from a cut that won’t stop after you have applied pressure for 10 minutes.  
• Black or bloody bowel movement  
• Red or brown urine  
• Small red spots on your skin called petechiae  
• Blood in your vomit  
• Coughing up blood  
• Changes in your vision 

It is important to tell your doctor or nurse if you notice any of the above signs.  

When your platelet count is very low you will be given a platelet transfusion to prevent bleeding. Some people can develop a reaction to a platelet transfusion, just like with a blood transfusion. Some reactions include chills, hives or breathing difficulties.  

Tell your doctor or nurse if you have ever had any reactions to platelet transfusions in the past.  

Here are some hints for avoiding problems when your platelet count is low:  

• Avoid strenuous activity or lifting heavy objects.  
• Avoid falls.  
• Use only an electric razor for shaving (women also).  
• Clean your teeth gently with a soft toothbrush. If your gums bleed when you floss your teeth, stop flossing for a few days, then try again.  
• Clean your nose by blowing gently into a tissue. Never use your fingers.  
• Avoid constipation.  
• If you cut yourself or if bleeding occurs, apply pressure using a clean cloth for at least 5 minutes.  
• If you have a nosebleed, sit upright with your head slightly forward and apply pressure just below the bridge of your nose until bleeding stops.   

The job of white blood cells is to help protect your body from infection by fighting off germs. Chemotherapy reduces the number of white blood cells and can increase your risk for getting an infection. Precautions will be taken to try to prevent you from getting bacterial, fungal and viral infections.    

If you have a fever when your white blood cell count is low (less than 1), it is very important that you get started on antibiotics right away even if you do not have any other signs of an infection. 

Signs of infection that should be reported to the doctor or nurse are:  

• Temperature over 38 C or 100.4 F  
• Chills and/or sweats  
• Redness and tenderness at your central venous catheter site  
• Diarrhea or painful anal area  
• Pain or burning when urinating  
• Nasal congestion  
• Cough with yellow or green phlegm  

What can you do to avoid getting an infection while your counts are low?   

• Wash your hands often, especially after using the washroom and before eating.  
• Tell all your visitors to wash their hands.  
• Tell any sick visitor to not visit you. If there is any concern about visitors being sick, they should visit you by electronic methods e.g., email, video call or telephone.  
• If any visitors have recently been exposed to someone who is sick, they should avoid visiting or wear a mask while they are around you.  
• Make sure family and friends who bring you food follow food safety guidelines. This is included in your patient manual. This will them how to prepare food safely, and the safer food choices to eat during this time.  
• Tell visitors not to use your bathroom.  
• Do not bring cut flowers or potted plants into your room, these can sometimes carry bacteria that can cause infections.  
• You should also try to reduce your risk of getting cut and bleeding because it can lead to an infection.  
• To help reduce your risk of bleeding, avoid shaving with a blade razor while your platelet count is low (there will be hair loss from the chemotherapy, so you may not need to shave).  
• Avoid using a toothpick and flossing your teeth if your gums bleed. Brush your teeth gently with a soft brush.  
• Clean your rectal area gently after each bowel movement and let the team know if any irritation or hemorrhoids occur.  
• Do not use rectal suppositories or enemas